Provider Demographics
NPI:1356447536
Name:TIFT COUNTY COMISSIONER OF ROADS & REVENUES
Entity Type:Organization
Organization Name:TIFT COUNTY COMISSIONER OF ROADS & REVENUES
Other - Org Name:TIFT COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVER
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-386-7924
Mailing Address - Street 1:PO BOX 1980
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1980
Mailing Address - Country:US
Mailing Address - Phone:229-386-7924
Mailing Address - Fax:229-386-7923
Practice Address - Street 1:1209 N TIFTON AVENUE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793
Practice Address - Country:US
Practice Address - Phone:229-386-7924
Practice Address - Fax:229-386-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13701341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000003077AMedicaid
GA85028359AAOtherMEDICARE PTAN